Cardiothoracic & vascular anesthesia
Factor XIII levels, clot strength, and impact of fibrinogen concentrate in infants undergoing cardiopulmonary bypass: a mechanistic sub-study of the FIBCON trial
Authors' conclusion
FXIII contribution to clot strength is considerable in infants undergoing cardiac surgery. Fibrinogen concentrate supplementation also increased FXIII activity, and hence clot strength.
Study context
- Population
- Infants undergoing cardiac surgery with CPB (median age 6.4 months)
- Participants
- 111 infants
- Comparison
- Fibrinogen concentrate vs placebo vs lower-bleeding-risk cohort
- Outcome
- Contribution of platelet number, fibrinogen concentration and FXIII activity to ROTEM clot strength (EXTEM-MCF)
- Follow-up
- Immediately before CPB and after separation from bypass
Methodological detailsprospectively planned, nested sub-study of the FIBCON trial
- Prospectively planned
- Nested sub-study of the FIBCON trial
Main finding
As reported in the abstract
Variability in EXTEM-MCF clot strength explained
Overall variability explained by three factors (multivariable R2)
48%
Factor XIII (FXIII) activity (partial R2)
0.21
Platelet number (partial R2)
0.14
Fibrinogen concentration (partial R2)
0.095
Further findings
Increase in FXIII activity during CPB
| Outcome | Fibrinogen concentrate | Placebo | Low-risk |
|---|---|---|---|
| Increase in fibrinogen concentration during CPB | 132% | 26% | 51% |
- Increase in FXIII activity during CPB: interaction P<0.0001
Change in mean platelet count during CPB
- Fell by a similar amount in the three groups
- −36% to −41%
- Interaction P=0.98
Original publication
Factor XIII levels, clot strength, and impact of fibrinogen concentrate in infants undergoing cardiopulmonary bypass: a mechanistic sub-study of the FIBCON trial. Br J Anaesth. Published 10 November 2022. doi:10.
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